RESUMEN
AIM: The aim of our study is to evaluate the surface glycoprotein CD133 as marker of cancer stem cells, as independent prognostic pattern of survival and its positive expression ratio to a chemotherapy increased resistance. METHODS: The study include our patient, affected by colorectal cancer (CRC) and underwent to surgery at University Hospital of Parma, with curative intent, with a follow up of 5 years; 47 cases were considered. All the cancer-case was considered independently by the histological grade. The monoclonal antibody CD133/1 (clone AC133-MAC, Miltenyi Bioetec, Auburn CA 95602, USA) that recognizes the epitope 1 of CD133 was utilized for the immunohistochemical process. RESULTS: On the total of 47 patients taken in exam, 8 were excluded for lack of date, 13 were lost during the follow-up. The final number of patients included in the study was 26(17 males and 9 females), medium age of 72.2 years. 2 Stage I, 8 Stage II A, 1 II B, 2 III A, 5 III B, 5 IIIC and 3 IV. Despite for 1, 25 on 26 patients were positive to CD133 (96.5 %), with different dye intensity, directly related at the positive cell pull. The CD133 positivity wasn't therefore related at any other clinic-pathological characteristic. CONCLUSION: The results obtained from our study goes in the same direction with others, that confirm a high representation of CD133 on the colic tumoral epithelium. It will be appropriate to do prospected and randomized studies, with a larger casistic, utilizing similar methods and a patients populations with more uniform characteristics, to verify the real role of CD133 and other molecules potentially marker of tumoral stem cell (TSC).
Asunto(s)
Antígenos CD/análisis , Biomarcadores de Tumor/análisis , Neoplasias Colorrectales/química , Neoplasias Colorrectales/diagnóstico , Resistencia a Antineoplásicos , Glicoproteínas/análisis , Péptidos/análisis , Antígeno AC133 , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Análisis de SupervivenciaRESUMEN
AIM: Postsurgical paralytic ileus is by definition an ileal paralysis longer than three days (72 hours) after a surgery on the gastrointestinal tract. At colorectal surgery we have performed on all candidates a visceral echo-color-Doppler to find a potential correlation with cardiovascular risk factors. METHODS: We have tested patients undergone to colorectal surgical resection performed by laparoscopic and laparotomic surgery, looking for their atherosclerosis status using ultrasound scan, postsurgical complication, bowel digestive function, anastomotic leak. We have also analyzed for each case the value of glycemia, azotemia, creatinemia, cholesterolemia, triglyceridemia, leukocytemia, mean cell volume, hemoglobinemia, albuminemia and moreover age, disease, pathology localization, kind of surgery, weight and height, body mass index (BMI), ASA status (American Society of Anesthesiologists, electrocardiographic distortions, nicotine dependency, diabetes mellitus type I and II). RESULTS: The study enrolled 23 patients, 10 male and 13 female. Middle age was 68.65 ± 11.85 years (range 39-90). In the female subgroup mean age was 69.48 years (range 39-90), while in the male subgroup it was 68 years (range 54-81). In 17 cases out of 23 (73.9%) there was a delay in digestive function, of over 72 hours, with a mean time duration of the paralytic ileus of 4.74 ± 1.60 days (range 3-9). Furthermore a statistically significant correlation between albuminemia and hemoglobinemia presurgery values and lower sierical albuminemia presurgery values in patients who were canalized too late (P=0.03; P=0.041) was found. The non-parametrical values analysis sec. Kruskal-Wallis emphasized a significant correlation between the canalization day, the elettrocardiographic evidence of the pathological situation (P=0.023) and the patient's smoking history (0.023). Another significant value was the creatininemia value: lower values of creatininemia were related to a delayed canalization (P=0.035). CONCLUSION: The statistical analysis does not allow to highlight any correlation between the ultrasound diagnosis of atherosclerosis and the delayed canalization.
Asunto(s)
Colectomía , Cuidados Preoperatorios , Ultrasonografía Doppler en Color , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , VíscerasRESUMEN
BACKGROUND: Right laparoscopic colectomy was introduced to colorectal surgery later than the left colon procedure. Three-trocar laparoscopy has already been used successfully in the treatment of gynecological cancers. In the present study, we aimed to analyze the feasibility of performing an associated gynecological procedure following abdominal laparoscopic exploration and to evaluate the suitability of laparoscopic right colectomy for treating elderly patients. METHODS: We conducted a review of prospectively collected data on 100 consecutive patients who were treated with right laparoscopic colectomy using three trocars from January 2005 to April 2010. We recorded the patients' age (<70 or > 70 years), ASA status, body mass index (BMI), pain on postoperative days 1 and 2 (POD 1, 2), nodes retrieved, laparotomic conversion, mean operative time, time to intestinal recovery, and length of postoperative stay. RESULTS: All subjects were treated for cancer. Conversion to the laparotomic procedure was performed in 13/100, with no difference in terms of age. Operative time was longer for laparotomic conversion (p <0.05), with a longer postoperative stay. Elderly patients had higher ASA scores (p < 0.005); age did not influence the conversion rate or BMI status. Pain on POD 1 and 2 differed between the laparotomic and laparoscopic groups (p <0.0001). Associated procedures were performed in five subjects (3 oophorectomy and 2 cholecystectomy). CONCLUSIONS: Laparoscopy using the three-trocar technique is a safe procedure for treating colon cancer, including in elderly patients, and enables associated gynecological laparoscopic procedures to be performed.
Asunto(s)
Colectomía/métodos , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Laparoscopía , Neoplasias Ováricas/secundario , Neoplasias Ováricas/cirugía , Factores de Edad , Anciano , Índice de Masa Corporal , Estudios de Factibilidad , Femenino , Humanos , Laparotomía , Tiempo de Internación , Ganglios Linfáticos/patología , Ovariectomía , Dolor Postoperatorio , Estudios Prospectivos , Instrumentos QuirúrgicosRESUMEN
Intestinal intussusception is rare in adults, but common in children. The ileocolic or appendiceal types are more frequent compared to the colo-colic one. We report successful laparoscopic left hemicolectomy in a patient with intussusception caused by a sigmoid tumor. Abdominal CT demonstrated a colo-colic intussusception at the level of the tumoral lesion with dilation of the proximal colon. The patient underwent urgent laparoscopic oncologically radical left hemicolectomy. A 10 cm Pfannenstiel incision allowed the removal of the resected segment. The laparoscopic approach was feasible because the dilation was moderate; however, if intussusception is due to cancer, laparoscopy can be safely performed if a correct and prompt diagnosis is achieved following oncologic criteria.
Asunto(s)
Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Intususcepción/patología , Intususcepción/cirugía , Laparoscopía/métodos , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/cirugía , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/diagnóstico , Anciano , Colectomía/métodos , Estudios de Factibilidad , Humanos , Intususcepción/diagnóstico , Intususcepción/etiología , Masculino , Neoplasias del Colon Sigmoide/complicaciones , Neoplasias del Colon Sigmoide/diagnóstico , Resultado del TratamientoAsunto(s)
Aneurisma de la Aorta Abdominal/complicaciones , Rotura de la Aorta/complicaciones , Colitis Isquémica/complicaciones , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Stents , Anciano de 80 o más Años , Constricción Patológica/cirugía , Estudios de Seguimiento , Humanos , Masculino , Diseño de Prótesis , Factores de TiempoRESUMEN
AIM: We analysed our experience of laparoscopic surgical treatment vs traditional surgery of right colon cancer. METHODS: A series of 27 patients was treated from January 2001 to December 2005 out of a total of 927 surgical colorectal operations in the same period (147 with the laparoscopic approach). Inclusion and exclusion criteria are reported. We compared this group with 25 patients treated by the same surgical group with open surgery. The mean operative time, the distance from the distal margin of resection, the number of lymphnodes, the mean period of canalization and the mean hospital stay are reported. RESULTS: In the laparoscopic group, the mean operative time was 124.8+/-36.3 min vs open surgery group of 94+/-23.6 min; the distance from the distal margin was 6.7+/-3.1 cm vs 6.4+/-2.1 cm; number of lymphnodes was 15.2+/-4.3 vs 18.7+/-2.9 nodes; and canalization 1.7+/-0.9 vs 2.7+/-0.7 days. The hospital stay was 6.8+/-1.7 vs 7.2+/-0.8 days. CONCLUSIONS: We consider laparoscopic right colon resection a safe procedure but it needs good laparoscopic practice and the observance of inclusion criteria.
Asunto(s)
Adenocarcinoma/cirugía , Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía , Adulto , Anciano , Femenino , Humanos , Tiempo de Internación , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: Percutaneous endoscopic gastrostomy (PEG) is a practical and safe option to place an alimentary gastrostomy. We observed that a relevant rate of complications are related to management of PEG. PATIENTS AND METHODS: We registered the patients treated in our Unit from September 1994 to December 2005. We placed 293 PEG (243 pts). Preferably using a tube 16 Fr, in 7 cases 18 Fr, in 21 cases 20 Fr and only in 3 cases 9 Fr. The median age was 69.8 years; ratio female:male 3:1. In 67 cases the treatment was carried out in not hospitalized patients. RESULTS: The incidence of late and early complications is statistically higher in hospitalized patients than at home. CONCLUSION: We think that a correct management of PEG (nurses correct information) and the experience of endoscopist and a dietician can significantly reduce the rate of complications.
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Trastornos de Deglución/terapia , Nutrición Enteral , Gastroscopía/efectos adversos , Gastrostomía/efectos adversos , Complicaciones Posoperatorias/prevención & control , Anciano , Trastornos de Deglución/fisiopatología , Nutrición Enteral/efectos adversos , Nutrición Enteral/instrumentación , Femenino , Gastrostomía/instrumentación , Humanos , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The authors analyzed their experience from January 2001 to February 2005 on 117 patients treated with Longo hemorrhoidopexy (46 cases) and Milligan-Morgan hemorroidectomy (71 cases). All the patients were observed after a week and one month after surgical procedure; at 6 months the Authors controlled 70 patients treated with Milligan-Morgan and 33 treated with Longo technique. The pain after 24 hours was the same in two groups but after a week a significative difference between two groups (p<0.05) was registered with a better quality of life for hemorrhoidopexy group. At 6 months pain during defecation was present in two cases of Longo group and in 6 cases of Milligan-Morgan group. In author's experience the Longo technique is a safe treatment with lower postsurgical pain and lower complications.
Asunto(s)
Hemorroides/cirugía , Distribución de Chi-Cuadrado , Interpretación Estadística de Datos , Defecación , Femenino , Estudios de Seguimiento , Hemorroides/diagnóstico , Humanos , Masculino , Métodos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Complicaciones Posoperatorias , Recurrencia , Seguridad , Engrapadoras Quirúrgicas , Técnicas de Sutura , Factores de TiempoRESUMEN
BACKGROUND: Authors generally agree that Giant Pancreatic Pseudocysts (> 10 cm) have a lower spontaneous resolution and are more difficult to treat than smaller pancreatic pseudocysts. This study was carried out on two groups of patients with larger and smaller pancreatic pseudocysts (pancreatic pseudocysts > 10 cm versus pancreatic pseudocysts < 10 cm), and aims to establish whether the size of pancreatic pseudocysts is a factor influencing treatment outcomes. PATIENTS AND METHODS: In a retrospective study, we examined 71 patients with pancreatic pseudocysts following an episode of acute pancreatitis, which were treated in our hospital from 1980 to 2000. Forty-one (57.5%) patients had a large pancreatic pseudocyst. Most patients underwent invasive treatments: 9 (12.6%) had percutaneous drainage, 37 (52.1%) open surgery and 13 (18.3%) endoscopic cyst gastrostomy. 12 patients (16.9%) of the 71 were cured with medical therapy alone. RESULTS: As far as the aetiology of the pancreatitis, location and number of the cysts were concerned, no major differences emerged between the two groups, although large pancreatic pseudocysts followed more severe pancreatitis (P = 0.0005). All giant pancreatic pseudocysts required invasive treatments; 40% of the pancreatic pseudocysts < 10 cm were successfully treated with medical therapy alone. No statistical differences were found regarding hospital mortality, morbidity, recurrence rate and hospital stay among the patients treated invasively. CONCLUSIONS: Giant pancreatic pseudocysts more often require invasive therapy due to persistent symptoms or complications. Treatment outcomes do not seem to be influenced by the size of the pancreatic pseudocysts.
Asunto(s)
Seudoquiste Pancreático/fisiopatología , Seudoquiste Pancreático/terapia , Procedimientos Quirúrgicos Operativos/métodos , Adulto , Anciano , Pesos y Medidas Corporales , Endoscopía del Sistema Digestivo/métodos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
It is known that prosthetic infection, graft-duodenal fistula, and erosion are possible late complications after aortic reconstruction, and that all these reported complications are accompanied generally by variable bleeding with different presentations. We report the case of a 63-year-old man who underwent a diagnostic upper gastrointestinal endoscopy for investigation of nausea, anorexia, asthenia, fever, and mild leukocytosis. The patient's medical history included a gastric resection for ulcer, with Billroth II gastrojejunostomy reconstruction and implantation of a Dacron vascular graft for abdominal aortic aneurysm 20 years and 3 years earlier, respectively. Abdomen ultrasonography showed hypoechoic area around an aortic prosthesis. Endoscopy found a foreign body corresponding to the vascular graft at the jejunum. No signs of bleeding were recorded. The patient was hospitalized and submitted to surgery that involved extra-anatomic axillofemoral bypass, bowel resection with a gastrojejunum Roux anastomosis, and prosthesis removal.
Asunto(s)
Anastomosis en-Y de Roux , Prótesis Vascular , Migración de Cuerpo Extraño , Yeyuno , Falla de Prótesis , Aneurisma de la Aorta Abdominal/cirugía , Endoscopía Gastrointestinal , Migración de Cuerpo Extraño/diagnóstico , Migración de Cuerpo Extraño/cirugía , Humanos , Yeyunostomía , Masculino , Persona de Mediana EdadRESUMEN
UNLABELLED: The preservation of the lung for transplantation for a long period is still a problem not solved. Euro-Collins (EC) and Belzer (UW) solution are the most widely used. The aim of this work is to analyse the direct influence of both EC and UW solutions on endothelial cells of human pulmonary artery by means of an ultrastructural analysis. The arteries were obtained from 3 patients that underwent pneumonectomy and prepared with the no touch technique. The arteries were divided in 15 specimens and preserved in EC and UW solution at 4 degrees C for 6 and 10 hours. The specimens were fixed in osmic acid veronal buffer 1% and embedded in Durcupan. Ultrastructural examination was done with transmission electron microscopy (TEM) and the influence of the solutions was evaluated using a grading scale with scores ranging from 0 to 4 that express the damages of the cellular wall, mitochondria and nuclei. The data are expressed as mean +/- standard deviation (n = 5). Student's t-test was used for statistical comparison between the solutions. RESULTS: after 6 hours of preservation in EC and UW the scores were 5.2 +/- 0.45 and 4.8 +/- 0.84 (p = 0.373) while after 10 hours were respectively 8.2 +/- 0.84 and 6.8 +/- 0.84 (p = 0.029). In conclusion our experimental model suggests that there are no significant differences between EC and UW after hypothermic 6 hours preservation while endothelial cells are better preserved after 10 hours in UW solution.
Asunto(s)
Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/ultraestructura , Soluciones Hipertónicas/farmacología , Soluciones Preservantes de Órganos , Arteria Pulmonar/efectos de los fármacos , Arteria Pulmonar/ultraestructura , Conservación de Tejido/métodos , Adenosina/farmacología , Alopurinol/farmacología , Glutatión/farmacología , Humanos , Insulina/farmacología , Rafinosa/farmacología , Factores de TiempoRESUMEN
During lung preservation, the vascular endothelium is probably the first site of damage and these lesions are considered the main limiting factor in solid-organ preservation. In the present study, the ultrastructural changes in the endothelial cells of human pulmonary artery hypothermically stored (at 4 degrees C) for 6 and 12 h in Euro-Collins, University of Wisconsin and Ringer-lactate solutions were compared. The arteries obtained from three patients who underwent pneumonectomy were divided into 20 segments and preserved in the three solutions mentioned. The specimens, which were fixed in osmic acid, were examined using transmission electron microscopy. Transmission electron microscopy indicated that the cells stored in the University of Wisconsin solution either for 6 or 12 h were the best preserved, while the most severely damaged cells were those stored in Euro-Collins solution, even after just 6 h. The cells stored in Ringer-lactate showed an intermediate level of damage. The data from an ultrastructural grading scale, which quantified the damage to the cytoplasm, mitochondria and nucleus, were in broad agreement with the general transmission electron microscopy observations. Analysis of variance of the grading scale data showed that there were statistically significant differences between the groups after both 6 and 12 h storage (P < 0.05).
Asunto(s)
Criopreservación , Endotelio Vascular/ultraestructura , Preservación de Órganos/métodos , Arteria Pulmonar/ultraestructura , Anciano , Análisis de Varianza , Humanos , Masculino , Persona de Mediana Edad , SolucionesRESUMEN
Hypercatabolism after operations has a negative influence on nutritional status, the healing process, infective complications and hospital stay. Moreover, the immune status of the patient has been shown to be equally important for septic morbidity and mortality. It is extensively accepted that in critical situations, an adequate nutritional support (enteral or parenteral) is absolutely necessary, but subjects such as the best way of feeding, the kind of nutrients to be used and the administration time are still debatable issues. Our aim was to evaluate the effectiveness (nutritional and immunological features) and clinical outcomes (septic morbidity and mortality) of total parenteral nutrition (TPN), early enteral nutrition and early enteral immunonutrition (EEN, EEIN) in 171 patients undergoing major abdominal and urological surgery for neoplastic pathology. Our prospective, randomised study showed no significant differences among the 3 nutritional supports (TPN, EEN, EEIN) with regard to restoration of normal nitrogen balance during the acute phase of surgical stress. No correlations were found in the 3 groups with immunoglobulin percentage, lymphocyte subpopulations and their functional patterns as studied by specific immunological tests. The skin test, on the other hand, seems to be more representative of the immune condition of the patients, demonstrating a faster improvement in immunological status in the EEIN group as compared to the control group. A smaller percentage of septic morbidity and mortality was found in both enteral nutritional groups (EEN and EEIN), although there was a statistically significant difference only between the TPN and EEIN groups. The hospital stay was 3.5 days shorter in enteral feeding patients (EEN, EEIN). Finally, EEN was less expensive than the other nutritional conditions, this result depending on the cost of the different materials used (infusion sets, linear filters, prepacked diets, etc.).
Asunto(s)
Abdomen/cirugía , Nutrición Enteral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
To perform ambulatorial surgery with local anaesthetics, it is important to carry out a correct postsurgical NSAID therapy avoiding the risks induced by these drugs. Two groups of patients submitted to ambulatorial hemorrhoidectomy were enrolled in a randomized study to evaluate the safety of NSAID therapy with or without the coadministration of misoprostol, a PGE1 analogue with gastroprotective action. Aim of this study was to evaluate if misoprostol in coadministration with NSAID could permit a correct domiciliary postsurgical NSAID therapy without gastric symptoms related to the NSAID therapy. From January 1990 to December 1991, 95 patients underwent hemorrhoidectomy and were discharged with analgesic therapy: the first group (n = 45) without gastroprotective therapy, the second group (n = 50) with the coadministration of misoprostol 200 mcg bid. After 7 and 14 days of treatment patients showed the following symptoms: in the first group 13.3% of the cases showed mild epigastric pain, 8.8% moderate epigastric pain and 4.4% severe epigastric pain with heartburn; in the second group (NSAID + misoprostol) only 4% of the cases showed moderate epigastric pain. The incidence of epigastric pain was statistically higher (p < 0.05) in patients treated with NSAID alone in comparison with the group treated with NSAID + misoprostol. The results, according to international literature, show that correct gastro-protective therapy with synthetic prostaglandins (misoprostol) is necessary for patients in treatment with NSAIDs.
Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Fisura Anal/cirugía , Mucosa Gástrica/efectos de los fármacos , Hemorroides/cirugía , Misoprostol/administración & dosificación , Adulto , Anciano , Canal Anal/efectos de los fármacos , Canal Anal/cirugía , Analgésicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Evaluación de Medicamentos , Quimioterapia Combinada , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
The spastic pelvic floor syndrome, caused by a paradox contraction of the sphincteric apparatus at defaecation instead of relaxing, leads to constipation with difficult evacuation. Forty patients (15 males and 25 females, average age 49 years, age range 15-78) affected by serious chronic idiopathic constipation, underwent, at our Institute, from June 1989 to September 1990, the following instrumental examinations: anal manometry; electromyography of the pelvic floor; proctogram; intestinal transit time; anorectal endoscopy; in addition, in 6 cases at risk for colorectal cancer, left colonoscopy. Fifteen patients showed dyskinetic functioning of the voluntary sphincteric apparatus. The following diagnostic methods proved to be of fundamental importance: proctogram, which revealed failure to open of the anorectal angle at defaecation (mean values: at rest 88.93 degrees +/- 6.62; at defaecation 88.93 degrees +/- 9.44); electromyography of the pelvic floor, which showed the anomalous contraction of the external anal sphincter. These patients were treated by means of an air inflated endoampullary balloon to evoke the sensation of a stool and its subsequent expulsion. The correct evacuating function was resumed definitely in 9 patients (60%); for the remaining 6 patients, regular sessions of re-education are still necessary. The spastic pelvic floor syndrome is a major cause of constipation and requires an accurate diagnostic method of investigating the correct functioning of the recto-pelvic region by means of the above-mentioned methods.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Estreñimiento/diagnóstico , Defecación , Pelvis , Espasmo/diagnóstico , Adolescente , Adulto , Anciano , Canal Anal/fisiopatología , Cateterismo , Estreñimiento/etiología , Estreñimiento/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espasmo/complicaciones , Espasmo/terapia , SíndromeRESUMEN
The Authors present their experience from 1980 to 2001 in the treatment of 5 cases of endometriosis. The median age is 26.5 years, the symptomatology was the presence of abdominal pain feces mixed with blood in two patients and in three cases a colorectal localization as well as a pelvic endometriosis. In a case the Authors have treated the patient with a surgical approach and in the others with a medical therapy with LH-RH analogs. Pathogenesis, symptomatology, diagnostics, medical and surgical therapy of this disease are also analyzed.
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Enfermedades del Colon , Endometriosis , Enfermedades del Recto , Adulto , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/tratamiento farmacológico , Enfermedades del Colon/cirugía , Colonoscopía , Endometriosis/diagnóstico , Endometriosis/tratamiento farmacológico , Endometriosis/cirugía , Femenino , Hormona Liberadora de Gonadotropina/análogos & derivados , Humanos , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/tratamiento farmacológico , Enfermedades del Recto/cirugía , Enfermedades del Sigmoide/diagnóstico , Enfermedades del Sigmoide/tratamiento farmacológico , Enfermedades del Sigmoide/cirugíaRESUMEN
The Authors report their experience in the treatment of bleeding gastric and duodenal ulcers by means of endoscopic sclerotherapy. From August 1988 to December 1989, 104 patients with haematemesis and/or melena were observed at the Clinica Chirurgica Generale, Toracica e Vascolare-Università di Parma. Endoscopy, carried out in the first 24 hours, led to the diagnosis of a bleeding gastric or duodenal ulcer in 73 cases; 22 of these patients underwent emergency sclerotherapy using 1:10,000 Adrenaline in association with 1% Polydocanol. Results obtained are the following: absolute haemostasis in 20 patients (91%), and surgical intervention in the other 2 cases for renewed haemorrhage. Among patients endoscopically treated, one death (5%) was recorded. Further complications were not encountered. The Authors believe sclerotherapy is reliable and quick thus representing a considerable therapeutic advance in the treatment of gastroduodenal haemorrhage, notoriously at high death rate (8-10%).
Asunto(s)
Úlcera Duodenal/complicaciones , Endoscopía , Úlcera Péptica Hemorrágica/terapia , Escleroterapia , Úlcera Gástrica/complicaciones , Adulto , Anciano , Femenino , Técnicas Hemostáticas , Humanos , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/cirugíaRESUMEN
Parathyroid carcinoma is a rare entity with an 0,5-1% of incidence on primary hyperparathyroidism (HPP) in literature. The very high values of calcium and parathormone (PTH) and the clinical aspects of hypercalcemia are the characteristics findings in these patients. We present our experience on 6 pts on 153 cases with HPP treated (3,9%). The clinical and diagnostic suspects are frequently intraoperative findings and the decision making for the surgeon is not always easy (parathyroidectomy with or without hemithyroidectomy, lymphadenectomy, surgical resection of other tissues). The mortality rate is high and we have registered three deaths at 8,14 and 64 months.
Asunto(s)
Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Paratiroidectomía/métodos , Tiroidectomía/métodos , Resultado del TratamientoRESUMEN
The Authors report their experience on laparoscopic colectomy in 38 patients treated between June 2001-September 2003 in General Surgery and Organ Transplantation Department of University of Parma, Italy. The patients were 23 male and 15 female, with average age 58.4 years. All patients were studied with TC and colonoscopy performed by the surgeon. The conversion rate was 15.8% and the average hospital stay 6.9 days (range 6-15 days). The patient's general clinical conditions and the results showed that the laparoscopic colectomy is a safe surgical option.
Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía , Colectomía/efectos adversos , Colectomía/instrumentación , Neoplasias del Colon/patología , Femenino , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The risk of dislodgment of endoclips placed during laparoscopic cholecystectomy in enlarged cystic duct is higher with minor bile leak. From January 2000 to April 2004, we performed 1013 procedures; in 12 patients we have showed a enlarged duct ligated with 4 laparoscopic cholecystectomy endoclips after a 180 degrees rotation of the gallbladder during a retrograde cholecystectomy. We haven't registered complications and all the cases were discharged the first postoperative day. The method is safe and economically sound.